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NPI 1487494811

NPI 1487494811 : EVENTUS WH SOUTHEAST, LLC : CHARLOTTE, NC

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General NPI Number Information
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    NPI Number           |    1487494811
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    Entity Type          |    Organization 
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    Legal Business Name  |    EVENTUS WH SOUTHEAST, LLC 
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Dates
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    Enumeration Date     |    05/31/2024
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    Last Update Date     |    10/25/2025
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Provider Practice Location Address
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    Address Line         |    212 S TYRON ST STE 1000 
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    City                 |    CHARLOTTE
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    State                |    NC
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    Zip                  |    28281-0006
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    Country              |    US
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    Telephone            |    855-743-2247
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    PO BOX 1431 DEPT 427 
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    City                 |    CHARLOTTE
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    State                |    NC
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    Zip                  |    28201-1431
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    Country              |    US
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    Telephone            |    
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    Fax                  |    
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Authorized Official
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    Title or Position    |    OWNER
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    Name                 |     GEORGE  HALL 
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    Credential           |    MD
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    Telephone            |    855-743-2247
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    363L00000X
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    Taxonomy Name        |    Nurse Practitioner
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    License Number       |    
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    License Number State |    
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Taxonomy #2
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    Taxonomy Code        |    207R00000X
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    Taxonomy Name        |    Internal Medicine Physician
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    License Number       |    
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    License Number State |    
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Taxonomy #3
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    Taxonomy Code        |    207QG0300X
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    Taxonomy Name        |    Geriatric Medicine (Family Medicine) Physician
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    License Number       |    
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    License Number State |    
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